Fill - Free fillable ROTH INDIVIDUAL RETIREMENT ACCOUNT APPLICATION (Kinecta) PDF form

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Roth IRA Simplifier

ROTH INDIVIDUAL RETIREMENT ACCOUNT APPLICATION

PART 1. ROTH IRA OWNER

Name (First/MI/Last)

Address Line 1

Address Line 2

City/State/ZIP

Social Security Number

Date of Birth Phone

Email Address

Account Number

PART 2. ROTH IRA CUSTODIAN

To be completed by the Roth IRA custodian

Name

Address Line 1

Address Line 2

City/State/ZIP

Phone Organization Number

This is an amendment to an existing Roth IRA.

PART 3. CONTRIBUTION INFORMATION

Contribution Amount Contribution Date

CONTRIBUTION TYPE (Select one)

Regular (Includes catch-up contributions)

Contribution for Tax Year

Rollover (Distribution from a Roth IRA or eligible employer-sponsored retirement plan that is being deposited into this Roth IRA)

By selecting this transaction, I irrevocably designate this contribution as a rollover.

Transfer (Direct movement of assets from a Roth IRA into this Roth IRA)

Recharacterization (A nontaxable movement of a Traditional IRA contribution into this Roth IRA)

By selecting this transaction, I irrevocably designate this contribution as a recharacterization.

Conversion (A taxable movement from a Traditional IRA or SIMPLE IRA into this Roth IRA)

By selecting this transaction, I irrevocably designate this contribution as a conversion.

PART 4. INVESTMENT AND DEPOSIT INFORMATION

INVESTMENT INFORMATION (Complete this section as applicable.)

Investment Description Quantity or Amount Investment Number Term or Maturity Date Interest Rate

DEPOSIT METHOD

Cash or Check (If the contribution type is transfer, the check must be from a financial organization made payable to the custodian for this Roth IRA.)

Internal Account

Account Number Type (e.g., checking, savings, IRA)

External Account (e.g., EFT, ACH, wire) (Additional documentation may be required and fees may apply.)

Name of Organization Sending the Assets Routing Number (Optional)

Account Number Type (e.g., checking, savings, IRA)

Deposit Taken by

6098 / 2400R-C (Rev. 4/2020)

KINECTA FEDERAL CREDIT UNION

1440 ROSECRANS AVE

MANHATTAN BEACH CA 90266

(800) 854-9846

11379

ELECTRONIC TRANSFER NOT AVAILABLE

XXXXXN/AXXXX

XXXXXXXXXXXXXXXN/AXXXXXXXXXXXX

XXXXXXXXXN/AXXXXXXXX

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Name of Roth IRA Owner , Account Number

PART 5. BENEFICIARY DESIGNATION

I designate that upon my death, the assets in this account be paid to the beneficiaries named below. The interest of any beneficiary that predeceases

me terminates completely, and the percentage share of any remaining beneficiaries will be increased on a pro rata basis. If no beneficiaries are named,

my estate will be my beneficiary.

I elect not to designate beneficiaries at this time and understand that I may designate beneficiaries at a later date.

PRIMARY BENEFICIARIES (The total percentage designated must equal 100%. If more than one beneficiary is designated and no percentages are

indicated, the beneficiaries will be deemed to own equal share percentages in the Roth IRA.)

Name

Address

City/State/ZIP

Date of Birth Relationship

Tax ID (SSN/TIN) Percent Designated

Name

Address

City/State/ZIP

Date of Birth Relationship

Tax ID (SSN/TIN) Percent Designated

Name

Address

City/State/ZIP

Date of Birth Relationship

Tax ID (SSN/TIN) Percent Designated

Name

Address

City/State/ZIP

Date of Birth Relationship

Tax ID (SSN/TIN) Percent Designated

CONTINGENT BENEFICIARIES (The total percentage designated must equal 100%. If more than one beneficiary is designated and no percentages are

indicated, the beneficiaries will be deemed to own equal share percentages in the Roth IRA. The balance in the account will be payable to these

beneficiaries if all primary beneficiaries have predeceased the Roth IRA owner.)

Name

Address

City/State/ZIP

Date of Birth Relationship

Tax ID (SSN/TIN) Percent Designated

Name

Address

City/State/ZIP

Date of Birth Relationship

Tax ID (SSN/TIN) Percent Designated

Name

Address

City/State/ZIP

Date of Birth Relationship

Tax ID (SSN/TIN) Percent Designated

Name

Address

City/State/ZIP

Date of Birth Relationship

Tax ID (SSN/TIN) Percent Designated

Check here if additional beneficiaries are listed on an attached addendum. Total number of addendums attached to this Roth IRA

PART 6. SPOUSAL CONSENT

Spousal consent should be considered if either the trust or the residence of

the Roth IRA owner is located in a community or marital property state.

CURRENT MARITAL STATUS

I Am Not Married – I understand that if I become married in the

future, I should review the requirements for spousal consent.

I Am Married – I understand that if I choose to designate a primary

beneficiary other than or in addition to my spouse, my spouse should

sign below.

CONSENT OF SPOUSE

I am the spouse of the above-named Roth IRA owner. I acknowledge that

I have received a fair and reasonable disclosure of my spouse’s property

and financial obligations. Because of the important tax consequences of

giving up my interest in this Roth IRA, I have been advised to see a tax

professional.

I hereby relinquish any interest that I may have in this Roth IRA and

consent to the beneficiary designation indicated above. I assume full

responsibility for any adverse consequences that may result.

Signature of Spouse Date (mm/dd/yyyy)

Signature of Witness Date (mm/dd/yyyy)

PART 7. SIGNATURES

Important: Please read before signing.

I understand the eligibility requirements for the type of Roth IRA contribution I

am making, and I state that I do qualify to make the contribution. I have received

a copy of the Roth IRA Application, 5305-RA Custodial Account Agreement, the

Financial Disclosure, and the Disclosure Statement. I understand that the terms

and conditions that apply to this Roth IRA are contained in this Application and

the Custodial Account Agreement. I agree to be bound by those terms and

conditions. Within seven days from the date I open this Roth IRA I may revoke it

without penalty by mailing or delivering a written notice to the custodian.

I assume complete responsibility for

• determining that I am eligible for a Roth IRA each year I make a

contribution,

• ensuring that all contributions I make are within the limits set forth

by the tax laws, and

• the tax consequences of any contributions (including rollover

contributions and conversions) and distributions.

Signature of Roth IRA Owner Date (mm/dd/yyyy)

Signature of Witness Date (mm/dd/yyyy)

Signature of Custodian Date (mm/dd/yyyy)

6098 / 2400R-C (Rev. 4/2020)

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ROTH INDIVIDUAL RETIREMENT CUSTODIAL ACCOUNT AGREEMENT

Form 5305-RA under section 408A of the Internal Revenue Code. FORM (Rev. April 2017)

The depositor named on the application is establishing a Roth individual

retirement account (Roth IRA) under section 408A to provide for his or her

retirement and for the support of his or her beneficiaries after death.

The custodian named on the application has given the depositor the

disclosure statement required by Regulations section 1.408-6.

The depositor has assigned the custodial account the sum indicated on

the application.

The depositor and the custodian make the following agreement:

ARTICLE I

Except in the case of a qualified rollover contribution described in section

408A(e) or a recharacterized contribution described in section 408A(d)(6),

the custodian will accept only cash contributions up to $5,500 per year for

2013 through 2017. For individuals who have reached the age of 50 by the

end of the year, the contribution limit is increased to $6,500 per year for

tax years 2013 through 2017. For years after 2017, these limits will be

increased to reflect a cost-of-living adjustment, if any.

ARTICLE II

1. The annual contribution limit described in Article I is gradually reduced

to $0 for higher income levels. For a depositor who is single or treated

as a single, the annual contribution is phased out between adjusted

gross income (AGI) of $118,000 and $133,000; for a married depositor

filing jointly, between AGI of $186,000 and $196,000; and for a married

depositor filing separately, between AGI of $0 and $10,000. These

phase-out ranges are for 2017. For years after 2017, the phase-out

ranges, except for the $0 to $10,000 range, will be increased to reflect

a cost-of-living adjustment, if any. Adjusted gross income is defined in

section 408A(c)(3).

2. In the case of a joint return, the AGI limits in the preceding paragraph

apply to the combined AGI of the depositor and his or her spouse.

ARTICLE III

The depositor’s interest in the balance in the custodial account is

nonforfeitable.

ARTICLE IV

1. No part of the custodial account funds may be invested in life insurance

contracts, nor may the assets of the custodial account be commingled

with other property except in a common trust fund or common

investment fund (within the meaning of section 408(a)(5)).

2. No part of the custodial account funds may be invested in collectibles

(within the meaning of section 408(m)) except as otherwise permitted

by section 408(m)(3), which provides an exception for certain gold,

silver, and platinum coins, coins issued under the laws of any state,

and certain bullion.

ARTICLE V

1. If the depositor dies before his or her entire interest is distributed to

him or her and the depositor’s surviving spouse is not the designated

beneficiary, the remaining interest will be distributed in accordance

with paragraph (a) below or, if elected or there is no designated

beneficiary, in accordance with paragraph (b) below:

(a) The remaining interest will be distributed, starting by the end of

the calendar year following the year of the depositor’s death, over

the designated beneficiary’s remaining life expectancy as

determined in the year following the death of the depositor.

(b) The remaining interest will be distributed by the end of the calendar

year containing the fifth anniversary of the depositor’s death.

2. The minimum amount that must be distributed each year under

paragraph 1(a) above is the account value at the close of business on

December 31 of the preceding year divided by the life expectancy (in

the single life table in Regulations section 1.401(a)(9)-9) of the

designated beneficiary using the attained age of the beneficiary in the

year following the year of the depositor’s death and subtracting one

from the divisor for each subsequent year.

3. If the depositor’s surviving spouse is the designated beneficiary, such

spouse will then be treated as the depositor.

ARTICLE VI

1. The depositor agrees to provide the custodian with all information

necessary to prepare any reports required by sections 408(i) and

408A(d)(3)(E), Regulations sections 1.408-5 and 1.408-6, or other

guidance published by the Internal Revenue Service (IRS).

2. The custodian agrees to submit to the IRS and depositor the reports

prescribed by the IRS.

ARTICLE VII

Notwithstanding any other articles which may be added or incorporated,

the provisions of Articles I through IV and this sentence will be controlling.

Any additional articles inconsistent with section 408A, the related

regulations, and other published guidance will be invalid.

ARTICLE VIII

This agreement will be amended as necessary to comply with the

provisions of the Code, the related Regulations, and other published

guidance. Other amendments may be made with the consent of the

persons whose signatures appear on the application.

ARTICLE IX

9.01 Definitions – In this part of this agreement (Article IX), the words

“you” and “your” mean the depositor. The words “we,” “us,” and

“our” mean the custodian. The word “Code” means the Internal

Revenue Code, and “regulations” means the Treasury regulations.

9.02 Notices and Change of Address – Any required notice regarding

this Roth IRA will be considered effective when we send it to the

intended recipient at the last address that we have in our records.

Any notice to be given to us will be considered effective when we

actually receive it. You, or the intended recipient, must notify us of

any change of address.

9.03 Representations and Responsibilities – You represent and warrant

to us that any information you have given or will give us with

respect to this agreement is complete and accurate. Further, you

agree that any directions you give us or action you take will be

proper under this agreement, and that we are entitled to rely upon

any such information or directions. If we fail to receive directions

from you regarding any transaction, if we receive ambiguous

directions regarding any transaction, or if we, in good faith, believe

that any transaction requested is in dispute, we reserve the right to

take no action until further clarification acceptable to us is received

from you or the appropriate government or judicial authority. We

will not be responsible for losses of any kind that may result from

your directions to us or your actions or failures to act, and you

agree to reimburse us for any loss we may incur as a result of such

directions, actions, or failures to act. We will not be responsible for

any penalties, taxes, judgments, or expenses you incur in connection

with your Roth IRA. We have no duty to determine whether your

contributions or distributions comply with the Code, regulations,

rulings, or this agreement.

6098 / 2400R-C (Rev. 4/2020)

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We may permit you to appoint, through written notice acceptable

to us, an authorized agent to act on your behalf with respect to

this agreement (e.g., attorney-in-fact, executor, administrator,

investment manager), but we have no duty to determine the

validity of such appointment or any instrument appointing such

authorized agent. We will not be responsible for losses of any kind

that may result from directions, actions, or failures to act by your

authorized agent, and you agree to reimburse us for any loss we

may incur as a result of such directions, actions, or failures to act

by your authorized agent.

You will have 60 days after you receive any documents, statements,

or other information from us to notify us in writing of any errors or

inaccuracies reflected in these documents, statements, or other

information. If you do not notify us within 60 days, the documents,

statements, or other information will be deemed correct and

accurate, and we will have no further liability or obligation for such

documents, statements, other information, or the transactions

described therein.

By performing services under this agreement we are acting as your

agent. You acknowledge and agree that nothing in this agreement

will be construed as conferring fiduciary status upon us. We will not

be required to perform any additional services unless specifically

agreed to under the terms and conditions of this agreement, or as

required under the Code and the regulations promulgated

thereunder with respect to Roth IRAs. You agree to indemnify and

hold us harmless for any and all claims, actions, proceedings,

damages, judgments, liabilities, costs, and expenses, including

attorney’s fees arising from or in connection with this agreement.

To the extent written instructions or notices are required under

this agreement, we may accept or provide such information in any

other form permitted by the Code or applicable regulations

including, but not limited to, electronic communication.

9.04 Disclosure of Account Information – We may use agents and/or

subcontractors to assist in administering your Roth IRA. We may

release nonpublic personal information regarding your Roth IRA to

such providers as necessary to provide the products and services

made available under this agreement, and to evaluate our business

operations and analyze potential product, service, or process

improvements.

9.05 Service Fees – We have the right to charge an annual service fee

or other designated fees (e.g., a transfer, rollover, or termination

fee) for maintaining your Roth IRA. In addition, we have the right

to be reimbursed for all reasonable expenses, including legal

expenses, we incur in connection with the administration of your

Roth IRA. We may charge you separately for any fees or expenses,

or we may deduct the amount of the fees or expenses from the

assets in your Roth IRA at our discretion. We reserve the right to

charge any additional fee after giving you 30 days’ notice. Fees

such as subtransfer agent fees or commissions may be paid to us

by third parties for assistance in performing certain transactions

with respect to this Roth IRA.

Any brokerage commissions attributable to the assets in your Roth

IRA will be charged to your Roth IRA. You cannot reimburse your

Roth IRA for those commissions.

9.06 Investment of Amounts in the Roth IRA – You have exclusive

responsibility for and control over the investment of the assets of

your Roth IRA. All transactions will be subject to any and all

restrictions or limitations, direct or indirect, that are imposed by

our charter, articles of incorporation, or bylaws; any and all

applicable federal and state laws and regulations; the rules,

regulations, customs and usages of any exchange, market or

clearing house where the transaction is executed; our policies and

practices; and this agreement. After your death, your beneficiaries

will have the right to direct the investment of your Roth IRA assets,

subject to the same conditions that applied to you during your

lifetime under this agreement (including, without limitation,

Section 9.03 of this article). We will have no discretion to direct

any investment in your Roth IRA. We assume no responsibility for

rendering investment advice with respect to your Roth IRA, nor

will we offer any opinion or judgment to you on matters concerning

the value or suitability of any investment or proposed investment

for your Roth IRA. In the absence of instructions from you, or if

your instructions are not in a form acceptable to us, we will have

the right to hold any uninvested amounts in cash, and we will have

no responsibility to invest uninvested cash unless and until

directed by you. We will not exercise the voting rights and other

shareholder rights with respect to investments in your Roth IRA

unless you provide timely written directions acceptable to us.

You will select the investment for your Roth IRA assets from those

investments that we are authorized by our charter, articles of

incorporation, or bylaws to offer and do in fact offer for Roth IRAs

(e.g., term share accounts, passbook accounts, certificates of

deposit, money market accounts.)

9.07 Beneficiaries – If you die before you receive all of the amounts in

your Roth IRA, payments from your Roth IRA will be made to your

beneficiaries. We have no obligation to pay to your beneficiaries

until such time we are notified of your death by receiving a valid

death certificate.

You may designate one or more persons or entities as beneficiary

of your Roth IRA. This designation can only be made on a form

provided by or acceptable to us, and it will only be effective when

it is filed with us during your lifetime. Each beneficiary designation

you file with us will cancel all previous designations. The consent

of your beneficiaries will not be required for you to revoke a

beneficiary designation. If you have designated both primary and

contingent beneficiaries and no primary beneficiary survives you,

the contingent beneficiaries will acquire the designated share of

your Roth IRA. If you do not designate a beneficiary or if all of your

primary and contingent beneficiaries predecease you, your estate

will be the beneficiary.

If your surviving spouse is the designated beneficiary, your spouse

may elect to treat your Roth IRA as his or her own Roth IRA, and

would not be subject to the required minimum distribution rules.

Your surviving spouse will also be entitled to such additional

beneficiary payment options as are granted under the Code or

applicable regulations.

We may allow, if permitted by state law, an original Roth IRA

beneficiary (the beneficiary who is entitled to receive distributions

from an inherited Roth IRA at the time of your death) to name

successor beneficiaries for the inherited Roth IRA. This designation

can only be made on a form provided by or acceptable to us, and

it will only be effective when it is filed with us during the original

Roth IRA beneficiary’s lifetime. Each beneficiary designation form

that the original Roth IRA beneficiary files with us will cancel all

previous designations. The consent of a successor beneficiary will

not be required for the original Roth IRA beneficiary to revoke a

successor beneficiary designation. If the original Roth IRA

beneficiary does not designate a successor beneficiary, his or her

estate will be the successor beneficiary. In no event will the

successor beneficiary be able to extend the distribution period

beyond that required for the original Roth IRA beneficiary.

If we so choose, for any reason (e.g., due to limitations of our

charter or bylaws), we may require that a beneficiary of a deceased

Roth IRA owner take total distribution of all Roth IRA assets by

December 31 of the year following the year of death.

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9.08 Termination of Agreement, Resignation, or Removal of Custodian –

Either party may terminate this agreement at any time by giving

written notice to the other. We can resign as custodian at any time

effective 30 days after we send written notice of our resignation to

you. Upon receipt of that notice, you must make arrangements to

transfer your Roth IRA to another financial organization. If you do

not complete a transfer of your Roth IRA within 30 days from the

date we send the notice to you, we have the right to transfer your

Roth IRA assets to a successor Roth IRA trustee or custodian that

we choose in our sole discretion, or we may pay your Roth IRA to

you in a single sum. We will not be liable for any actions or failures

to act on the part of any successor trustee or custodian, nor for

any tax consequences you may incur that result from the transfer

or distribution of your assets pursuant to this section.

If this agreement is terminated, we may charge to your Roth IRA a

reasonable amount of money that we believe is necessary to cover

any associated costs, including but not limited to one or more of

the following.

• Any fees, expenses, or taxes chargeable against your Roth IRA

• Any penalties or surrender charges associated with the early

withdrawal of any savings instrument or other investment in

your Roth IRA

If we are a nonbank custodian required to comply with Regulations

section 1.408-2(e) and we fail to do so or we are not keeping the

records, making the returns, or sending the statements as are

required by forms or regulations, the IRS may require us to

substitute another trustee or custodian.

We may establish a policy requiring distribution of the entire

balance of your Roth IRA to you in cash or property if the balance

of your Roth IRA drops below the minimum balance required

under the applicable investment or policy established.

9.09 Successor Custodian – If our organization changes its name,

reorganizes, merges with another organization (or comes under

the control of any federal or state agency), or if our entire

organization (or any portion that includes your Roth IRA) is bought

by another organization, that organization (or agency) will

automatically become the trustee or custodian of your Roth IRA,

but only if it is the type of organization authorized to serve as a

Roth IRA trustee or custodian.

9.10 Amendments – We have the right to amend this agreement at any

time. Any amendment we make to comply with the Code and

related regulations does not require your consent. You will be

deemed to have consented to any other amendment unless,

within 30 days from the date we send the amendment, you notify

us in writing that you do not consent.

9.11 Withdrawals or Transfers – All requests for withdrawal or transfer

will be in writing on a form provided by or acceptable to us. The

method of distribution must be specified in writing or in any other

method acceptable to us. The tax identification number of the

recipient must be provided to us before we are obligated to make

a distribution. Withdrawals will be subject to all applicable tax and

other laws and regulations, including but not limited to possible

early distribution penalty taxes, surrender charges, and withholding

requirements.

You are not required to take a distribution from your Roth IRA

during your lifetime. At your death, however, your beneficiaries

must begin taking distributions in accordance with Article V and

section 9.07 of this article. We will make no distributions to you

from your Roth IRA until you provide us with a written request for

a distribution on a form provided by or acceptable to us.

9.12 Transfers From Other Plans – We can receive amounts transferred

to this Roth IRA from the trustee or custodian of another Roth IRA

as permitted by the Code. In addition, we can accept rollovers of

eligible rollover distributions from employer-sponsored retirement

plans as permitted by the Code. We reserve the right not to accept

any transfer.

9.13 Liquidation of Assets – We have the right to liquidate assets in

your Roth IRA if necessary to make distributions or to pay fees,

expenses, taxes, penalties, or surrender charges properly

chargeable against your Roth IRA. If you fail to direct us as to

which assets to liquidate, we will decide, in our complete and sole

discretion, and you agree to not hold us liable for any adverse

consequences that result from our decision.

9.14 Restrictions on the Fund – Neither you nor any beneficiary may

sell, transfer, or pledge any interest in your Roth IRA in any manner

whatsoever, except as provided by law or this agreement.

The assets in your Roth IRA will not be responsible for the debts,

contracts, or torts of any person entitled to distributions under

this agreement.

9.15 What Law Applies – This agreement is subject to all applicable

federal and state laws and regulations. If it is necessary to apply

any state law to interpret and administer this agreement, the law

of our domicile will govern.

If any part of this agreement is held to be illegal or invalid, the

remaining parts will not be affected. Neither your nor our failure to

enforce at any time or for any period of time any of the provisions

of this agreement will be construed as a waiver of such provisions,

or your right or our right thereafter to enforce each and every such

provision.

GENERAL INSTRUCTIONS

Section references are to the Internal Revenue Code unless otherwise noted.

PURPOSE OF FORM

Form 5305-RA is a model custodial account agreement that meets the

requirements of section 408A. However, only Articles I through VIII have

been reviewed by the IRS. A Roth individual retirement account (Roth IRA)

is established after the form is fully executed by both the individual

(depositor) and the custodian. This account must be created in the United

States for the exclusive benefit of the depositor and his or her beneficiaries.

Do not

file Form 5305-RA with the IRS. Instead, keep it with your records.

Unlike contributions to Traditional individual retirement arrangements,

contributions to a Roth IRA are not deductible from the depositor’s gross

income; and distributions after five years that are made when the depositor

is 59½ years of age or older or on account of death, disability, or the

purchase of a home by a first-time homebuyer (limited to $10,000), are not

includible in gross income. For more information on Roth IRAs, including

the required disclosures the custodian must give the depositor, see Pub.

590-A, Contributions to Individual Retirement Arrangements (IRAs), and

Pub. 590-B, Distributions from Individual Retirement Arrangements (IRAs).

DEFINITIONS

Custodian – The custodian must be a bank or savings and loan association,

as defined in section 408(n), or any person who has the approval of the

IRS to act as custodian.

Depositor – The depositor is the person who establishes the custodial

account.

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Page 6 of 13

SPECIFIC INSTRUCTIONS

Article I – The depositor may be subject to a six percent tax on excess

contributions if (1) contributions to other individual retirement

arrangements of the depositor have been made for the same tax year,

(2) the depositor’s adjusted gross income exceeds the applicable limits in

Article II for the tax year, or (3) the depositor’s and spouse’s compensation

is less than the amount contributed by or on behalf of them for the tax

year.

Article V – This article describes how distributions will be made from the

Roth IRA after the depositor’s death. Elections made pursuant to this

article should be reviewed periodically to ensure they correspond to the

depositor’s intent. Under paragraph three of Article V, the depositor’s

spouse is treated as the owner of the Roth IRA upon the death of the

depositor, rather than as the beneficiary. If the spouse is to be treated as

the beneficiary and not the owner, an overriding provision should be

added to Article IX.

Article IX – Article IX and any that follow it may incorporate additional

provisions that are agreed to by the depositor and custodian to complete

the agreement. They may include, for example, definitions, investment

powers, voting rights, exculpatory provisions, amendment and termination,

removal of the custodian, custodian’s fees, state law requirements,

beginning date of distributions, accepting only cash, treatment of excess

contributions, prohibited transactions with the depositor, etc. Attach

additional pages if necessary.

DISCLOSURE STATEMENT

RIGHT TO REVOKE YOUR ROTH IRA

You have the right to revoke your Roth IRA within seven days of the

receipt of the disclosure statement. If revoked, you are entitled to a full

return of the contribution you made to your Roth IRA. The amount

returned to you would not include an adjustment for such items as sales

commissions, administrative expenses, or fluctuation in market value.

You may make this revocation only by mailing or delivering a written

notice to the custodian at the address listed on the application.

If you send your notice by first class mail, your revocation will be deemed

mailed as of the postmark date.

If you have any questions about the procedure for revoking your Roth IRA,

please call the custodian at the telephone number listed on the application.

REQUIREMENTS OF A ROTH IRA

A. Cash Contributions

–

Your contribution must be in cash, unless it is a

rollover or conversion contribution.

B. Maximum Contribution – The total amount you may contribute to a

Roth IRA for any taxable year cannot exceed the lesser of 100 percent

of your compensation or $6,000 for 2019 and 2020, with possible

cost-of-living adjustments each year thereafter. If you also maintain a

Traditional IRA (i.e., an IRA subject to the limits of Internal Revenue

Code Sections (IRC Secs.) 408(a) or 408(b)), the maximum contribution

to your Roth IRAs is reduced by any contributions you make to your

Traditional IRAs. Your total annual contribution to all Roth IRAs and

Traditional IRAs cannot exceed the lesser of the dollar amounts

described above or 100 percent of your compensation.

Your Roth IRA contribution is further limited if your modified adjusted

gross income (MAGI) equals or exceeds $193,000 (for 2019) or

$196,000 (for 2020) if you are a married individual filing a joint income

tax return, or equals or exceeds $122,000 (for 2019) or $124,000 (for

2020) if you are a single individual. Married individuals filing a joint

income tax return with MAGI equaling or exceeding $203,000 (for

2019) or $206,000 (for 2020) may not fund a Roth IRA. Single individuals

with MAGI equaling or exceeding $137,000 (for 2019) or $139,000 (for

2020) may not fund a Roth IRA. Married individuals filing a separate

income tax return with MAGI equaling or exceeding $10,000 may not

fund a Roth IRA. The MAGI limits described above are subject to cost-

of-living increases for tax years beginning after 2020.

If you are married filing a joint income tax return and your MAGI is

between the applicable MAGI phase-out range for the year, your

maximum Roth IRA contribution is determined as follows. (1) Begin

with the appropriate MAGI phase-out maximum for the applicable

year and subtract your MAGI; (2) divide this total by the difference

between the phase-out range maximum and minimum; and

(3) multiply this number by the maximum allowable contribution for

the applicable year, including catch-up contributions if you are age 50

or older. For example, if you are age 30 with MAGI of $201,000, your

maximum Roth IRA contribution for 2020 is $3,000 ([$206,000 minus

$201,000] divided by $10,000 and multiplied by $6,000).

If you are single and your MAGI is between the applicable MAGI

phase-out for the year, your maximum Roth IRA contribution is

determined as follows. (1) Begin with the appropriate MAGI phase-

out maximum for the applicable year and subtract your MAGI;

(2) divide this total by the difference between the phase-out range

maximum and minimum; and (3) multiply this number by the

maximum allowable contribution for the applicable year, including

catch-up contributions if you are age 50 or older. For example, if you

are age 30 with MAGI of $127,000, your maximum Roth IRA

contribution for 2020 is $4,800 ([$139,000 minus $127,000] divided

by $15,000 and multiplied by $6,000).

Contribution Eligibility –

You are eligible to make a regular contribution

to your Roth IRA, regardless of your age, if you have compensation

and your MAGI is below the maximum threshold. Your Roth IRA

contribution is not limited by your participation in an employer-

sponsored retirement plan, other than a Traditional IRA.

D. Catch-Up Contributions

–

If you are age 50 or older by the close of the

taxable year, you may make an additional contribution to your Roth

IRA. The maximum additional contribution is $1,000 per year.

E. Nonforfeitability

–

Your interest in your Roth IRA is nonforfeitable.

F. Eligible Custodians

–

The custodian of your Roth IRA must be a bank,

savings and loan association, credit union, or a person or entity

approved by the Secretary of the Treasury.

Commingling Assets –

The assets of your Roth IRA cannot be

commingled with other property except in a common trust fund or

common investment fund.

H. Life Insurance

–

No portion of your Roth IRA may be invested in life

insurance contracts.

6098 / 2400R-C (Rev. 4/2020)

Page 7 of 13

I. Collectibles

–

You may not invest the assets of your Roth IRA in

collectibles (within the meaning of IRC Sec. 408(m)). A collectible is

defined as any work of art, rug or antique, metal or gem, stamp or

coin, alcoholic beverage, or other tangible personal property specified

by the Internal Revenue Service (IRS). However, specially minted

United States gold and silver coins, and certain state-issued coins are

permissible investments. Platinum coins and certain gold, silver,

platinum, or palladium bullion (as described in IRC Sec. 408(m)(3)) are

also permitted as Roth IRA investments.

J. Beneficiary Distributions – Upon your death, your beneficiaries are

required to take distributions according to IRC Sec. 401(a)(9) and

Treasury Regulation 1.408-8. These requirements are described below.

1. Death of Roth IRA Owner Before January 1, 2020 – Your

designated beneficiary is determined based on the beneficiaries

designated as of the date of your death, who remain your

beneficiaries as of September 30 of the year following the year of

your death. The entire amount remaining in your account will, at

the election of your designated beneficiaries, either

(a) be distributed by December 31 of the year containing the fifth

anniversary of your death, or

(b) be distributed over the remaining life expectancy of your

designated beneficiaries.

If your spouse is your sole designated beneficiary, he or she must

elect either option (a) or (b) by the earlier of December 31 of the

year containing the fifth anniversary of your death, or December 31

of the year life expectancy payments would be required to begin.

Your designated beneficiaries, other than a spouse who is the sole

designated beneficiary, must elect either option (a) or (b) by

December 31 of the year following the year of your death. If no

election is made, distribution will be calculated in accordance with

option (b). In the case of distributions under option (b),

distributions must commence by December 31 of the year

following the year of your death. Generally, if your spouse is the

designated beneficiary, distributions need not commence until

December 31 of the year you would have attained age 72 (70½ if

you would have attained 70½ before 2020), if later. If a beneficiary

other than a person or qualified trust as defined in the Treasury

Regulations is named, you will be treated as having no designated

beneficiary of your Roth IRA for purposes of determining the

distribution period. If there is no designated beneficiary of your

Roth IRA, the entire Roth IRA must be distributed by December 31

of the year containing the fifth anniversary of your death.

2. Death of Roth IRA Owner On or After January 1, 2020 – The entire

amount remaining in your account will generally be distributed by

December 31 of the year containing the tenth anniversary of your

death unless you have an eligible designated beneficiary or you

have no designated beneficiary for purposes of determining a

distribution period.

If your beneficiary is an eligible designated beneficiary, the entire

amount remaining in your account may be distributed (in

accordance with the Treasury Regulations) over the remaining life

expectancy of your eligible designated beneficiary (or over a period

not extending beyond the life expectancy of such beneficiary).

An eligible designated beneficiary is any designated beneficiary

who is

• your surviving spouse,

• your child who has not reached the age of majority,

• disabled (A physician must determine that your impairment

can be expected to result in death or to be of long, continued,

and indefinite duration.),

• an individual who is not more than 10 years younger than you, or

• chronically ill (A chronically ill individual is someone who (1) is

unable to perform (without substantial assistance from another

individual) at least two activities of daily living for an indefinite

period due to a loss of functional capacity, (2) has a level of

disability similar to the level of disability described above

requiring assistance with daily living based on loss of functional

capacity, or (3) requires substantial supervision to protect the

individual from threats to health and safety due to severe

cognitive impairment.)

Note that certain trust beneficiaries (e.g., certain trusts for

disabled and chronically ill individuals) may take distribution of the

entire amount remaining in your account over the remaining life

expectancy of the trust beneficiary.

Generally, life expectancy distributions to an eligible designated

beneficiary must commence by December 31 of the year following

the year of your death. However, if your spouse is the eligible

designated beneficiary, distributions need not commence until

December 31 of the year you would have attained age 72, if later.

If your eligible designated beneficiary is your minor child, life

expectancy payments must begin by December 31 of the year

following the year of your death and continue until the child

reaches the age of majority. Once the age of majority is reached,

the beneficiary will have 10 years to deplete the account.

If a beneficiary other than a person (e.g., your estate, a charity, or

a certain type of trust) is named, you will be treated as having no

designated beneficiary of your Roth IRA for purposes of

determining the distribution period. If there is no designated

beneficiary of your Roth IRA, the entire Roth IRA must be

distributed by December 31 of the year containing the fifth

anniversary of your death.

A spouse who is the sole designated beneficiary of your entire Roth

IRA will be deemed to elect to treat your Roth IRA as his or her own

by either (1) making contributions to your Roth IRA or (2) failing to

timely remove a required minimum distribution from your Roth IRA.

Regardless of whether or not the spouse is the sole designated

beneficiary of your Roth IRA, a spouse beneficiary may roll over his or

her share of the assets to his or her own Roth IRA.

If we so choose, for any reason (e.g., due to limitations of our charter

or bylaws), we may require that a beneficiary of a deceased Roth IRA

owner take total distribution of all Roth IRA assets by December 31 of

the year following the year of death.

If your beneficiary fails to remove a required minimum distribution

after your death, an additional penalty tax of 50 percent is imposed

on the amount of the required minimum distribution that should have

been taken but was not. Your beneficiary must file IRS Form 5329

along with his or her income tax return to report and remit any

additional taxes to the IRS.

K. Waiver of 2020 RMD – In spite of the general rules described above,

no beneficiary life expectancy payments are required for calendar year

2020. In addition, if the five-year rule applies to a Roth IRA with respect

to any decedent, the five-year period is determined without regard to

calendar year 2020. For example, if a Roth IRA owner died in 2017, the

beneficiary’s five-year period ends in 2023 instead of 2022.

INCOME TAX CONSEQUENCES OF ESTABLISHING A ROTH IRA

A. Contributions Not Deducted

–

No deduction is allowed for Roth IRA

contributions, including transfers, rollovers, and conversion contributions.

B. Contribution Deadline

–

The deadline for making a Roth IRA

contribution is your tax return due date (not including extensions).

You may designate a contribution as a contribution for the preceding

taxable year in a manner acceptable to us. For example, if you are a

Page 8 of 13

calendar-year taxpayer and you make your Roth IRA contribution on

or before your tax filing deadline, your contribution is considered to

have been made for the previous tax year if you designate it as such.

If you are a member of the Armed Forces serving in a combat zone,

hazardous duty area, or contingency operation, you may have an

extended contribution deadline of 180 days after the last day served

in the area. In addition, your contribution deadline for a particular tax

year is also extended by the number of days that remained to file that

year’s tax return as of the date you entered the combat zone. This

additional extension to make your Roth IRA contribution cannot

exceed the number of days between January 1 and your tax filing

deadline, not including extensions.

C. Tax Credit for Contributions

–

You may be eligible to receive a tax

credit for your Roth IRA contributions. This credit may not exceed

$1,000 in a given year. You may be eligible for this tax credit if you are

• age 18 or older as of the close of the taxable year,

• not a dependent of another taxpayer, and

• not a full-time student.

The credit is based upon your income (see chart below), and will range

from 0 to 50 percent of eligible contributions. In order to determine

the amount of your contributions, add all of the contributions made to

your Roth IRA and reduce these contributions by any distributions that

you have taken during the testing period. The testing period begins

two years prior to the year for which the credit is sought and ends on

the tax return due date (including extensions) for the year for which

the credit is sought. In order to determine your tax credit, multiply the

applicable percentage from the chart below by the amount of your

contributions that do not exceed $2,000.

2019 Adjusted Gross Income*

Applicable

Percentage

Joint

Return

Head of a

Household

All Other

Cases

$1 – 38,500 $1 – 28,875 $1 – 19,250 50

$38,501

– 41,500 $28,876 – 31,125 $19,251 – 20,750 20

$41,501

– 64,000 $31,126 – 48,000 $20,751 – 32,000 10

Over $64,000 Over $48,000 Over $32,000 0

2020 Adjusted Gross Income*

Applicable

Percentage

Joint

Return

Head of a

Household

All Other

Cases

– 39,000 $1 – 29,250 $1 – 19,500 50

$39,001

– 42,500 $29,251 – 31,875 $19,501 – 21,250 20

$42,501

– 65,000 $31,876 – 48,750 $21,251 – 32,500 10

Over $65,000 Over $48,750 Over $32,500 0

*Adjusted gross income (AGI) includes foreign earned income and

income from Guam, America Samoa, North Mariana Islands, and Puerto

Rico. AGI limits are subject to cost-of-living adjustments each year.

D. Excess Contributions

–

An excess contribution is any amount that is

contributed to your Roth IRA that exceeds the amount that you are

eligible to contribute. If the excess is not corrected timely, an

additional penalty tax of six percent will be imposed upon the excess

amount. The procedure for correcting an excess is determined by the

timeliness of the correction as identified below.

1. Removal Before Your Tax Filing Deadline. An excess contribution

may be corrected by withdrawing the excess amount, along with the

earnings attributable to the excess, before your tax filing deadline,

including extensions, for the year for which the excess contribution

was made. An excess withdrawn under this method is not taxable to

you, but you must include the earnings attributable to the excess in

your taxable income in the year in which the contribution was made.

The six percent excess contribution penalty tax will be avoided.

2. Removal After Your Tax Filing Deadline. If you are correcting an

excess contribution after your tax filing deadline, including

extensions, remove only the amount of the excess contribution.

The six percent excess contribution penalty tax will be imposed on

the excess contribution for each year it remains in the Roth IRA. An

excess withdrawal under this method is not taxable to you.

3. Carry Forward to a Subsequent Year. If you do not withdraw the

excess contribution, you may carry forward the contribution for a

subsequent tax year. To do so, you under-contribute for that tax

year and carry the excess contribution amount forward to that

year on your tax return. The six percent excess contribution

penalty tax will be imposed on the excess amount for each year

that it remains as an excess contribution at the end of the year.

You must file IRS Form 5329 along with your income tax return to

report and remit any additional taxes to the IRS.

E. Tax-Deferred Earnings

–

The investment earnings of your Roth IRA

are not subject to federal income tax as they accumulate in your Roth

IRA. In addition, distributions of your Roth IRA earnings will be free

from federal income tax if you take a qualified distribution, as

described below.

Taxation of Distributions

–

The taxation of Roth IRA distributions

depends on whether the distribution is a qualified distribution or a

nonqualified distribution.

1. Qualified Distributions. Qualified distributions from your Roth IRA

(both the contributions and earnings) are not included in your

income. A qualified distribution is a distribution that is made after

the expiration of the five-year period beginning January 1 of the

first year for which you made a contribution to any Roth IRA

(including a conversion from a Traditional IRA), and is made on

account of one of the following events.

• Attainment of age 59½

• Disability

• First-time homebuyer purchase

• Death

For example, if you made a contribution to your Roth IRA for 2015,

the five-year period for determining whether a distribution is a

qualified distribution is satisfied as of January 1, 2020.

2. Nonqualified Distributions. If you do not meet the requirements

for a qualified distribution, any earnings you withdraw from your

Roth IRA will be included in your gross income and, if you are

under age 59½, may be subject to an early distribution penalty tax.

However, when you take a distribution, the amounts you

contributed annually to any Roth IRA and any military death

gratuity or Servicemembers’ Group Life Insurance (SGLI) payments

that you rolled over to a Roth IRA, will be deemed to be removed

first, followed by conversion and employer-sponsored retirement

plan rollover contributions made to any Roth IRA on a first-in, first-

out basis. Therefore, your nonqualified distributions will not be

taxable to you until your withdrawals exceed the amount of your

annual contributions, rollovers of your military death gratuity or

SGLI payments, and your conversions and employer-sponsored

retirement plan rollovers.

Income Tax Withholding

–

Any nonqualified withdrawal of earnings

from your Roth IRA may be subject to federal income tax withholding.

You may, however, elect not to have withholding apply to your Roth

IRA withdrawal. If withholding is applied to your withdrawal, not less

than 10 percent of the amount withdrawn must be withheld.

Early Distribution Penalty Tax

–

If you are under age 59½ and receive a

nonqualified Roth IRA distribution, an additional early distribution

penalty tax of 10 percent generally will apply to the amount includible

in income in the year of the distribution. If you are under age 59½ and

Page 9 of 13

receive a distribution of conversion amounts or employer-sponsored

retirement plan rollover amounts within the five-year period beginning

with the year in which the conversion or employer-sponsored

retirement plan rollover occurred, an additional early distribution

penalty tax of 10 percent generally will apply to the amount of the

distribution. The additional early distribution penalty tax of 10 percent

generally will not apply if one of the following exceptions apply.

1) Death. After your death, payments made to your beneficiary are not

subject to the 10 percent early distribution penalty tax. 2) Disability. If

you are disabled at the time of distribution, you are not subject to the

additional 10 percent early distribution penalty tax. In order to be

disabled, a physician must determine that your impairment can be

expected to result in death or to be of long, continued, and indefinite

duration. 3) Substantially equal periodic payments. You are not

subject to the additional 10 percent early distribution penalty tax if

you are taking a series of substantially equal periodic payments (at

least annual payments) over your life expectancy or the joint life

expectancy of you and your beneficiary. You must continue these

payments for the longer of five years or until you reach age 59½.

4) Unreimbursed medical expenses. If you take payments to pay for

unreimbursed medical expenses that exceed a specified percentage of

your adjusted gross income, you will not be subject to the 10 percent

early distribution penalty tax. For further detailed information and

effective dates you may obtain IRS Publication 590-B, Distributions

from Individual Retirement Arrangements (IRAs), from the IRS. The

medical expenses may be for you, your spouse, or any dependent

listed on your tax return.

5) Health insurance premiums. If you are

unemployed and have received unemployment compensation for

12 consecutive weeks under a federal or state program, you may take

payments from your Roth IRA to pay for health insurance premiums

without incurring the 10 percent early distribution penalty tax.

6) Higher education expenses. Payments taken for certain qualified

higher education expenses for you, your spouse, or the children or

grandchildren of you or your spouse, will not be subject to the

10 percent early distribution penalty tax. 7) First-time homebuyer.

You may take payments from your Roth IRA to use toward qualified

acquisition costs of buying or building a principal residence. The

amount you may take for this reason may not exceed a lifetime

maximum of $10,000. The payment must be used for qualified

acquisition costs within 120 days of receiving the distribution. 8) IRS

levy. Payments from your Roth IRA made to the U.S. government in

response to a federal tax levy are not subject to the 10 percent early

distribution penalty tax. 9) Qualified reservist distributions. If you are

a qualified reservist member called to active duty for more than

179 days or an indefinite period, the payments you take from your

Roth IRA during the active duty period are not subject to the 10 percent

early distribution penalty tax. 10) Qualified birth or adoption.

Payments from your Roth IRA for the birth of your child or the adoption

of an eligible adoptee will not be subject to the 10 percent early

distribution penalty tax if the distribution is taken during the one-year

period beginning on the date of birth of your child or the date on

which your legal adoption of an eligible adoptee is finalized. An eligible

adoptee means any individual (other than your spouse’s child) who

has not attained age 18 or is physically or mentally incapable of self-

support. The aggregate amount you may take for this reason may not

exceed $5,000 for each birth or adoption.

You must file IRS Form 5329 along with your income tax return to the

IRS to report and remit any additional taxes or to claim a penalty tax

exception.

I. Required Minimum Distributions

–

You are not required to take

distributions from your Roth IRA during your lifetime (as required for

Traditional and savings incentive match plan for employees of small

employers (SIMPLE) IRAs). However, your beneficiaries generally are

required to take distributions from your Roth IRA after your death.

See the section titled Beneficiary Payouts in this disclosure statement

regarding beneficiaries’ required minimum distributions.

J. Rollovers and Conversions

–

Your Roth IRA may be rolled over to

another Roth IRA of yours, may receive rollover contributions, or may

receive conversion contributions, provided that all of the applicable

rollover or conversion rules are followed. Rollover is a term used to

describe a movement of cash or other property to your Roth IRA from

another Roth IRA, or from your employer’s qualified retirement plan,

403(a) annuity, 403(b) tax-sheltered annuity, 457(b) eligible

governmental deferred compensation plan, or federal Thrift Savings

Plan. Conversion is a term used to describe the movement of

Traditional IRA or SIMPLE IRA assets to a Roth IRA. A conversion

generally is a taxable event. The general rollover and conversion rules

are summarized below. These transactions are often complex. If you

have any questions regarding a rollover or conversion, please see a

competent tax advisor.

1. Roth IRA-to-Roth IRA Rollovers. Assets distributed from your Roth

IRA may be rolled over to the same Roth IRA or another Roth IRA of

yours if the requirements of IRC Sec. 408(d)(3) are met. A proper

Roth IRA-to-Roth IRA rollover is completed if all or part of the

distribution is rolled over not later than 60 days after the distribution

is received. In the case of a distribution for a first-time homebuyer

where there was a delay or cancellation of the purchase, the 60-day

rollover period may be extended to 120 days. Roth IRA assets may

not be rolled over to other types of IRAs (e.g., Traditional IRA,

SIMPLE IRA), or employer-sponsored retirement plans.

You are permitted to roll over only one distribution from an IRA

(Traditional, Roth, or SIMPLE) in a 12-month period, regardless of

the number of IRAs you own. A distribution may be rolled over to

the same IRA or to another IRA that is eligible to receive the

rollover. For more information on rollover limitations, you may

wish to obtain IRS Publication 590-B, Distributions from Individual

Retirement Arrangements (IRAs), from the IRS or refer to the IRS

website at www.irs.gov.

2. Traditional IRA-to-Roth IRA Conversions. If you convert to a Roth

IRA, the amount of the conversion from your Traditional IRA to

your Roth IRA will be treated as a distribution for income tax

purposes, and is includible in your gross income (except for any

nondeductible contributions). Although the conversion amount

generally is included in income, the 10 percent early distribution

penalty tax will not apply to conversions from a Traditional IRA to

a Roth IRA, regardless of whether you qualify for any exceptions to

the 10 percent early distribution penalty tax. If you are required to

take a required minimum distribution for the year, you must

remove your required minimum distribution before converting

your Traditional IRA.

3. SIMPLE IRA-to-Roth IRA Conversions. You are eligible to convert

all or any portion of your existing SIMPLE IRA into your Roth IRA,

provided two years have passed since you first participated in a

SIMPLE IRA plan sponsored by your employer. The amount of the

conversion from your SIMPLE IRA to your Roth IRA will be treated

as a distribution for income tax purposes and is includible in your

gross income. Although the conversion amount generally is

included in income, the 10 percent early distribution penalty tax

will not apply to conversions from a SIMPLE IRA to a Roth IRA,

regardless of whether you qualify for any exceptions to the

10 percent early distribution penalty tax. If you are required to

take a required minimum distribution for the year, you must

remove your required minimum distribution before converting

your SIMPLE IRA.

Page 10 of 13

4. Rollovers of Roth Elective Deferrals. Roth elective deferrals

distributed from a 401(k) cash or deferred arrangement, 403(b)

tax-sheltered annuity, 457(b) eligible governmental deferred

compensation plan, or federal Thrift Savings Plan, may be rolled

into your Roth IRA.

5. Employer-Sponsored Retirement

Plan-to-Roth

IRA Rollovers. You

may roll over, directly or indirectly, any eligible rollover distribution

from an eligible employer-sponsored retirement plan to your Roth

IRA. An eligible rollover distribution is defined generally as any

distribution from a qualified retirement plan, 403(a) annuity, 403(b)

tax-sheltered annuity, 457(b) eligible governmental deferred

compensation plan, or federal Thrift Savings Plan unless it is a

required minimum distribution, hardship distribution, part of a

certain series of substantially equal periodic payments, corrective

distributions of excess contributions, excess deferrals, excess

annual additions and any income allocable to the excess, deemed

loan distribution, dividends on employer securities, or the cost of

life insurance coverage.

If you are conducting an indirect rollover, your eligible rollover

distribution generally must be rolled over to your Roth IRA not later

than 60 days after you receive the distribution. In the case of a plan

loan offset due to plan termination or severance from employment,

the deadline for completing the rollover is your tax return due date

(including extensions) for the year in which the offset occurs.

If you are a spouse or nonspouse beneficiary of a deceased

employer-sponsored retirement plan participant, or the trustee of

an eligible type of trust named as beneficiary of such participant,

you may directly roll over inherited assets from a qualified

retirement plan, 403(a) annuity, 403(b) tax-sheltered annuity, or

457(b) eligible governmental deferred compensation plan to an

inherited Roth IRA, as permitted by the IRS. The Roth IRA must be

maintained as an inherited Roth IRA, subject to the beneficiary

distribution requirements.

Although the rollover amount generally is included in income, the

10 percent early distribution penalty tax will not apply to rollovers

from eligible employer-sponsored retirement plans to a Roth IRA

or inherited Roth IRA, regardless of whether you qualify for any

exceptions to the 10 percent early distribution penalty tax.

6. Beneficiary Rollovers From 401(k), 403(b), or 457(b) Eligible

Governmental Plans Containing Roth Elective Deferrals. If you are

a spouse beneficiary, nonspouse beneficiary, or the trustee of an

eligible type of trust named as beneficiary of a deceased 401(k),

403(b), or 457(b) eligible governmental deferred compensation

plan participant who had made Roth elective deferrals to the plan,

you may directly roll over the Roth elective deferrals and their

earnings to an inherited Roth IRA, as permitted by the IRS. The

Roth IRA must be maintained as an inherited Roth IRA, subject to

the beneficiary distribution requirements.

7. Rollovers of Military Death Benefits. If you receive or have

received a military death gratuity or a payment from the SGLI

program, you may be able to roll over the proceeds to your Roth

IRA. The rollover contribution amount is limited to the sum of the

death benefits or SGLI payment received, less any such amount

that was rolled over to a Coverdell education savings account.

Proceeds must be rolled over within one year of receipt of the

gratuity or SGLI payment for deaths occurring on or after June 17,

2008. Any amount that is rolled over under this provision is

considered nontaxable basis in your Roth IRA.

8. Qualified HSA Funding Distribution. If you are eligible to contribute

to a health savings account (HSA), you may be eligible to take a

one-time tax-free qualified HSA funding distribution from your

Roth IRA and directly deposit it to your HSA. The amount of the

qualified HSA funding distribution may not exceed the maximum

HSA contribution limit in effect for the type of high deductible

health plan coverage (i.e., single or family coverage) that you have

at the time of the deposit, and counts toward your HSA contribution

limit for that year. For further detailed information, you may wish

to obtain IRS Publication 969, Health Savings Accounts and Other

Tax-Favored Health Plans.

9. Rollovers of Settlement Payments From Bankrupt Airlines. If

you are a qualified airline employee who has received a qualified

airline settlement payment from a commercial airline carrier

under the approval of an order of a federal bankruptcy court in a

case filed after September 11, 2001, and before January 1, 2007,

you are allowed to roll over any portion of the proceeds into

your Roth IRA within 180 days after receipt of such amount, or by

a later date if extended by federal law. For further detailed

information and effective dates you may obtain IRS Publication

590-A, Contributions to Individual Retirement Arrangements

(IRAs), from the IRS or refer to the IRS website at www.irs.gov.

10. Rollovers of Exxon Valdez Settlement Payments. If you receive a

qualified settlement payment from Exxon Valdez litigation, you

may roll over the amount of the settlement, up to $100,000,

reduced by the amount of any qualified Exxon Valdez settlement

income previously contributed to a Traditional or Roth IRA or

eligible retirement plan in prior taxable years. You will have until

your tax return due date (not including extensions) for the year in

which the qualified settlement income is received to make the

rollover contribution. To obtain more information on this type of

rollover, you may wish to visit the IRS website at www.irs.gov.

11. Rollover of IRS Levy. If you receive a refund of eligible retirement

plan assets that had been wrongfully levied, you may roll over the

amount returned up until your tax return due date (not including

extensions) for the year in which the money was returned.

12. Repayment of Qualified Birth or Adoption Distribution. If you

have taken a qualified birth or adoption distribution, you may

generally repay all or a portion of the aggregate amount of such

distribution to a Roth IRA, as permitted by the IRS. For further

information, you may wish to obtain IRS Publication 590-A,

Contributions to Individual Retirement Arrangements (IRAs), by

visiting www.irs.gov on the Internet.

13. Written Election. At the time you make a rollover or conversion to

a Roth IRA, you must designate in writing to the custodian your

election to treat that contribution as a rollover or conversion.

Once made, the election is irrevocable.

K. Transfer Due to Divorce

–

If all or any part of your Roth IRA is awarded

to your spouse or former spouse in a divorce or legal separation

proceeding, the amount so awarded will be treated as the spouse’s

Roth IRA (and may be transferred pursuant to a court-approved

divorce decree or written legal separation agreement to another Roth

IRA of your spouse), and will not be considered a taxable distribution

to you. A transfer is a tax-free direct movement of cash and/or

property from one Roth IRA to another.

L. Recharacterizations

–

If you make a contribution to a Traditional IRA

and later recharacterize either all or a portion of the original

contribution to a Roth IRA along with net income attributable, you may

elect to treat the original contribution as having been made to the

Roth IRA. The same methodology applies when recharacterizing a

contribution from a Roth IRA to a Traditional IRA. The deadline for

completing a recharacterization is your tax filing deadline (including

any extensions) for the year for which the original contribution was

made. You may not recharacterize a Roth IRA conversion or an

employer-sponsored retirement plan rollover.

Page 11 of 13

LIMITATIONS AND RESTRICTIONS

A. Spousal Roth IRA

–

If you are married and have compensation, you

may contribute to a Roth IRA established for the benefit of your

spouse, regardless of whether or not your spouse has compensation.

You must file a joint income tax return for the year for which the

contribution is made.

The amount you may contribute to your Roth IRA and your spouse’s

Roth IRA is the lesser of 100 percent of your combined eligible

compensation or $12,000 for 2019 and 2020. This amount may be

increased with cost-of-living adjustments each year. However, you

may not contribute more than the individual contribution limit to

each Roth IRA. Your contribution may be further limited if your MAGI

falls within the minimum and maximum thresholds.

If your spouse is age 50 or older by the close of the taxable year, and

is otherwise eligible, you may make an additional contribution to your

spouse’s Roth IRA. The maximum additional contribution is $1,000

per year.

B. Gift Tax

–

Transfers of your Roth IRA assets to a beneficiary made

during your life and at your request may be subject to federal gift tax

under IRC Sec. 2501.

C. Special Tax Treatment

–

Capital gains treatment and 10-year income

averaging authorized by IRC Sec. 402 do not apply to Roth IRA

distributions.

D. Prohibited Transactions

–

If you or your beneficiary engage in a

prohibited transaction with your Roth IRA, as described in IRC Sec.

4975, your Roth IRA will lose its tax-deferred or tax-exempt status,

and you generally must include the value of the earnings in your

account in your gross income for that taxable year. The following

transactions are examples of prohibited transactions with your Roth

IRA. (1) Taking a loan from your Roth IRA (2) Buying property for

personal use (present or future) with Roth IRA assets (3) Receiving

certain bonuses or premiums because of your Roth IRA.

E. Pledging

–

If you pledge any portion of your Roth IRA as collateral for

a loan, the amount so pledged will be treated as a distribution and

may be included in your gross income for that year.

OTHER

A. IRS Plan Approval

–

Articles I through VIII of the agreement used to

establish this Roth IRA have been approved by the IRS. The IRS

approval is a determination only as to form. It is not an endorsement

of the plan in operation or of the investments offered.

B. Additional Information

–

For further information on Roth IRAs, you

may wish to obtain IRS Publication 590-A, Contributions to Individual

Retirement Arrangements (IRAs), or Publication 590-B, Distributions

from Individual Retirement Arrangements (IRAs), by calling 800-TAX-

FORM, or by visiting www.irs.gov on the Internet.

Important Information About Procedures for Opening a New Account –

To help the government fight the funding of terrorism and money

laundering activities, federal law requires all financial organizations to

obtain, verify, and record information that identifies each person who

opens an account. Therefore, when you open a Roth IRA, you are

required to provide your name, residential address, date of birth, and

identification number. We may require other information that will

allow us to identify you.

D. Qualified Reservist Distributions

–

If you are an eligible qualified

reservist who has taken penalty-free qualified reservist distributions

from your Roth IRA or retirement plan, you may recontribute those

amounts to a Roth IRA generally within a two-year period from your

date of return.

E. Qualified Charitable Distributions

–

If you are age 70½ or older, you

may be eligible to take tax-free Roth IRA distributions of up to $100,000

per year and have these distributions paid directly to certain charitable

organizations. Special tax rules may apply. For further detailed

information and effective dates you may obtain IRS Publication 590-B,

Distributions from Individual Retirement Arrangements (IRAs), from

the IRS or refer to the IRS website at www.irs.gov.

F. Disaster Related Relief

–

If you qualify (for example, you sustained an

economic loss due to, or are otherwise considered affected by, certain

disasters designated by Congress), you may be eligible for favorable

tax treatment on distributions, rollovers, and other transactions

involving your Roth IRA. Qualified disaster relief may include penalty-

tax free early distributions made during specified timeframes for each

disaster, the ability to include distributions in your gross income

ratably over multiple years, the ability to roll over distributions to an

eligible retirement plan without regard to the 60-day rollover rule,

and more. For additional information on specific disasters, including a

complete listing of disaster areas, qualification requirements for

relief, and allowable disaster-related Roth IRA transactions, you may

wish to obtain IRS Publication 590-B, Distributions from Individual

Retirement Arrangements (IRAs), from the IRS or refer to the IRS

website at www.irs.gov.

G. Coronavirus-Related Distributions (CRDs) – If you qualify, you may

withdraw up to $100,000 in aggregate from your IRAs and eligible

retirement plans as a CRD, without paying the 10 percent early

distribution penalty tax. You are a qualified individual if you (or your

spouse or dependent) is diagnosed with the COVID-19 disease or the

SARS-CoV-2 virus in an approved test; or if you have experienced

adverse financial consequences as a result of being quarantined, being

furloughed or laid off or having work hours reduced due to such virus

or disease, being unable to work due to lack of child care due to such

virus or disease, closing or reduced hours of a business owned or

operated by you due to such virus or disease, or other factors as

determined by the IRS. A CRD must be made on or after January 1,

2020, and before December 31, 2020.

CRDs will be taxed ratably over a three-year period, unless you elect

otherwise, and may be repaid over three years beginning with the day

following the day a CRD is made. Repayments may be made to an

eligible retirement plan or IRA.

An eligible retirement plan is defined as a qualified retirement plan,

403(a) annuity, 403(b) tax-sheltered annuity, 457(b) eligible

governmental deferred compensation plan, or an IRA.

Page 12 of 13

IRA

FINANCIAL DISCLOSURE

The term IRA will be used below to mean Traditional IRA, Roth IRA, and SIMPLE IRA, unless otherwise specified.

The financial organization should complete the financial disclosure using Method I, Method II, or Method III.

If the growth of the IRA can reasonably be

projected, use either Method I or Method II. The account values projected using Method I or Method II must be reduced by all applicable fees and penalties. If

annual fees are assessed, such as an annual service fee, use Method II. If no projection of growth of the IRA can reasonably be shown, use Method III.

METHOD I Growth can be projected (Do not use Method I if an annual fee is charged. Instead, use Method II for financial projections.)

Your Age on Your Birth Date This Year Length of Time Deposit (If applicable)

The charts below give projections of the value of your IRA by showing the amount available at the end of each year. These projections assume an

interest rate of .25%, compounded annually. If you have invested your IRA in a time deposit, a loss-of-earnings penalty may be charged against a

withdrawal before maturity. A transaction fee may also apply to your IRA.

The Regular Contribution chart assumes that an annual contribution of $1,000 is made on the first day of each year. The Rollover, Transfer, or Conversion*

chart assumes that a one-time deposit of $1,000 is made on the first day of the first year.

Indicate the projected account value for each of the years, taking into consideration any applicable loss of earnings penalty or other fees assessed if

the IRA owner received a distribution at the end of the year for which the projection is being made. First, circle the year-end projected IRA value that

is applicable for each of the first five years. Next, circle the applicable IRA value for the years in which the IRA owner will attain ages 60, 65, and 70.

REGULAR CONTRIBUTION

FINANCIAL PROJECTIONS WITH .25% RATE OF INTEREST

NO.

YRS

ACCOUNT

VALUE

1 MONTH

PENALTY

3 MONTH

PENALTY

6 MONTH

PENALTY

AMT. AFTER

FEES AND

PENALTIES

1 $1,002.50 $1,002.29 $1,001.87 $1,001.25

2 2,007.51 2,007.09 2,006.25 2,005.00

3 3,015.03 3,014.40 3,013.14 3,011.26

4 4,025.06 4,024.22 4,022.55 4,020.03

5 5,037.63 5,036.58 5,034.48 5,031.33

6 6,052.72 6,051.46 6,048.94 6,045.15

7 7,070.35 7,068.88 7,065.93 7,061.51

8 8,090.53 8,088.84 8,085.47 8,080.41

9 9,113.25 9,111.35 9,107.56 9,101.86

10 10,138.54 10,136.42 10,132.20 10,125.86

11 11,166.38 11,164.06 11,159.40 11,152.42

12 12,196.80 12,194.26 12,189.18 12,181.55

13 13,229.79 13,227.03 13,221.52 13,213.25

14 14,265.37 14,262.39 14,256.45 14,247.53

15 15,303.53 15,300.34 15,293.96 15,284.40

16 16,344.29 16,340.88 16,334.07 16,323.86

17 17,387.65 17,384.03 17,376.78 17,365.91

18 18,433.62 18,429.78 18,422.10 18,410.58

19 19,482.20 19,478.14 19,470.02 19,457.85

20 20,533.41 20,529.13 20,520.57 20,507.74

21 21,587.24 21,582.74 21,573.75 21,560.26

22 22,643.71 22,638.99 22,629.56 22,615.40

23 23,702.82 23,697.88 23,688.00 23,673.19

24 24,764.57 24,759.42 24,749.10

24,733.62

25,828.99 25,823.61 25,812.84 25,796.70

26,896.06 26,890.46 26,879.25 26,862.44

27 27,965.80 27,959.97 27,948.32 27,930.84

28 29,038.21 29,032.16 29,020.06 29,001.92

29 30,113.31 30,107.04 30,094.49 30,075.67

30 31,191.09 31,184.59 31,171.60 31,152.10

31 32,271.57 32,264.85 32,251.40 32,231.23

32 33,354.75 33,347.80 33,333.90 33,313.06

33 34,440.64 34,433.46 34,419.11 34,397.58

34 35,529.24 35,521.84 35,507.03 35,484.83

35 36,620.56 36,612.93 36,597.67 36,574.78

36 37,714.61 37,706.75 37,691.04 37,667.47

37 38,811.40 38,803.31 38,787.14 38,762.88

38 39,910.93 39,902.61 39,885.98 39,861.04

39 41,013.20 41,004.66 40,987.57 40,961.94

40 42,118.24 42,109.46 42,091.91 42,065.59

41 43,226.03 43,217.03 43,199.02 43,172.00

42 44,336.60 44,327.36 44,308.89 44,281.18

43 45,449.94 45,440.47 45,421.53 45,393.13

44 46,566.06 46,556.36 46,536.96 46,507.86

45 47,684.98 47,675.04 47,655.18 47,625.37

46 48,806.69 48,796.52 48,776.19 48,745.68

47 49,931.21 49,920.81 49,900.00 49,868.79

48 51,058.54 51,047.90 51,026.62 50,994.71

49 52,188.68 52,177.81 52,156.06 52,123.45

50 53,321.65 53,310.55 53,288.33 53,255.00

51 54,457.46 54,446.11

54,423.42 54,389.39

52 55,596.10 55,584.52 55,561.35 55,526.61

53 56,737.59 56,725.77 56,702.13 56,666.67

54 57,881.94 57,869.88 57,845.76 57,809.58

55 59,029.14 59,016.84 58,992.25 58,955.35

56 60,179.21 60,166.68 60,141.60 60,103.99

57 61,332.16 61,319.38 61,293.83 61,255.50

58 62,487.99 62,474.97 62,448.94 62,409.88

59 63,646.71 63,633.45 63,606.93 63,567.15

60 64,808.33 64,794.83 64,767.82 64,727.32

61 65,972.85 65,959.11 65,931.62 65,890.38

62 67,140.28 67,126.29 67,098.32 67,056.36

ROLLOVER, TRANSFER, OR CONVERSION*

FINANCIAL PROJECTIONS WITH .25% RATE OF INTEREST

NO.

YRS

ACCOUNT

VALUE

1 MONTH

PENALTY

3 MONTH

PENALTY

6 MONTH

PENALTY

AMT. AFTER

FEES AND

PENALTIES

1 $1,002.50 $1,002.29 $1,001.87 $1,001.25

2 1,005.01 1,004.80 1,004.38 1,003.75

3 1,007.52 1,007.31 1,006.89 1,006.26

4 1,010.04 1,009.83 1,009.41 1,008.78

5 1,012.56 1,012.35 1,011.93 1,011.30

6 1,015.09 1,014.88 1,014.46 1,013.83

7 1,017.63 1,017.42 1,017.00 1,016.36

8 1,020.18 1,019.96 1,019.54 1,018.90

9 1,022.73 1,022.51 1,022.09 1,021.45

10 1,025.28 1,025.07 1,024.64 1,024.00

11 1,027.85 1,027.63 1,027.20 1,026.56

12 1,030.42 1,030.20 1,029.77 1,029.13

13 1,032.99 1,032.78 1,032.35 1,031.70

14 1,035.57 1,035.36 1,034.93 1,034.28

15 1,038.16 1,037.95 1,037.51 1,036.87

16 1,040.76 1,040.54 1,040.11 1,039.46

17 1,043.36 1,043.14 1,042.71 1,042.06

18 1,045.97 1,045.75 1,045.32 1,044.66

19 1,048.58 1,048.37 1,047.93 1,047.27

20 1,051.21 1,050.99 1,050.55 1,049.89

21 1,053.83 1,053.61 1,053.17 1,052.52

22 1,056.47 1,056.25 1,055.81 1,055.15

23 1,059.11 1,058.89 1,058.45 1,057.79

24 1,061.76 1,061.54 1,061.09

1,060.43

1,064.41 1,064.19 1,063.75

1,063.08

26 1,067.07 1,066.85 1,066.41 1,065.74

27 1,069.74 1,069.52 1,069.07 1,068.40

28 1,072.41 1,072.19 1,071.74 1,071.07

29 1,075.10 1,074.87 1,074.42 1,073.75

30 1,077.78 1,077.56 1,077.11 1,076.44

31 1,080.48 1,080.25 1,079.80 1,079.13

32 1,083.18 1,082.95 1,082.50 1,081.82

33 1,085.89 1,085.66 1,085.21 1,084.53

34 1,088.60 1,088.37 1,087.92 1,087.24

35 1,091.32 1,091.10 1,090.64 1,089.96

36 1,094.05 1,093.82 1,093.37 1,092.68

37 1,096.79 1,096.56 1,096.10 1,095.42

38 1,099.53 1,099.30 1,098.84 1,098.15

39 1,102.28 1,102.05 1,101.59 1,100.90

40 1,105.03 1,104.80 1,104.34 1,103.65

41 1,107.80 1,107.56 1,107.10 1,106.41

42 1,110.57 1,110.33 1,109.87 1,109.18

43 1,113.34 1,113.11 1,112.65 1,111.95

44 1,116.12 1,115.89 1,115.43 1,114.73

45 1,118.92 1,118.68 1,118.22 1,117.52

46 1,121.71 1,121.48 1,121.01 1,120.31

47 1,124.52 1,124.28 1,123.81 1,123.11

48 1,127.33 1,127.09 1,126.62 1,125.92

49 1,130.15 1,129.91 1,129.44 1,128.73

50 1,132.97 1,132.74 1,132.26 1,131.56

51 1,135.80 1,135.57

1,135.09 1,134.38

52 1,138.64 1,138.41 1,137.93

1,137.22

53 1,141.49 1,141.25 1,140.78 1,140.06

54 1,144.34 1,144.11 1,143.63 1,142.91

55 1,147.20 1,146.97 1,146.49 1,145.77

56 1,150.07 1,149.83 1,149.35 1,148.64

57 1,152.95 1,152.71 1,152.23 1,151.51

58 1,155.83 1,155.59 1,155.11 1,154.39

59 1,158.72 1,158.48 1,158.00 1,157.27

60 1,161.62 1,161.37 1,160.89 1,160.16

61 1,164.52 1,164.28 1,163.79 1,163.07

62 1,167.43 1,167.19 1,166.70 1,165.97

*Conversion applies to Roth IRAs only

ADDITIONAL FINANCIAL DISCLOSURE

INFORMATION

The account values shown are projections based

on many assumptions. They are not guaranteed,

but depend upon many factors, including the

interest rates and terms of future funding

instruments.

We may charge you fees in connection with your

IRA. If we do not charge these fees now, we may

do so in the future after giving you notice. If you

do not pay these fees separately, they may be

paid from the assets of your IRA.

CURRENT FEES

6098 / 2400R-C (Rev. 4/2020)

IRA Trustee Transfer

25.00

IRA Closeout

25.00

Page 13 of 13

METHOD II Growth can be projected

The financial projections below show the amount that would be available

if you were to withdraw your IRA assets at the indicated times. These

projections are based on the following assumptions.

CONTRIBUTION (Select one)

Regular. An annual $1,000 deposit is made on the first day of each

year.

Rollover, Transfer, or Conversion.* A one-time $1,000 deposit is

made on the first day of the first year.

Your Age on Your Birth Date in Contribution Year

Investment Instrument

Length of Time Deposit

Rate of Interest %

Compounding Method

FINANCIAL PROJECTIONS

Number of

Years in IRA

Program

Total

Accumulation

of IRA Dollars

Amount

After Fees

and Penalties

1 Year

$ $

2 Years

$ $

3 Years

$ $

4 Years

$ $

5 Years

$ $

End of the

Year You

Reach Age

Total

Accumulation

of IRA Dollars

Amount

After Fees

and Penalties

$ $

ADDITIONAL FINANCIAL DISCLOSURE INFORMATION

The account values shown are projections based on many assumptions.

These projections have been reduced by any applicable fees. They are not

guaranteed, but depend upon many factors, including the interest rates

and terms of future funding instruments.

We may charge you an annual service fee or other fees in connection with

your IRA. If we do not charge these fees now, we may do so in the future

after giving you notice. If you do not pay these fees separately, they may

be paid from the assets of your IRA.

CURRENT FEES

*Conversion applies to Roth IRAs only

METHOD III Growth cannot be projected

The value of your IRA will be dependent solely upon the performance of

any investment instrument used to fund your IRA. Therefore, no projection

of the growth of your IRA can reasonably be shown or guaranteed.

Terms and conditions of the IRA that affect your investment are listed

below.

INVESTMENT OPTIONS

Your IRA will be invested in products that we offer directly or those we

offer through a relationship with a registered securities broker-dealer.

FEES

There are certain fees and charges connected with your IRA investments.

These fees and charges may include the following.

• Sales Commissions

• Investment Management Fees

• Distribution Fees

• Set Up Fees

• Annual Maintenance Fees

• Surrender or Termination Fees

To find out what fees apply, refer to the investment prospectus or contract.

There may be certain fees and charges connected with the IRA itself.

(Select and complete as applicable.)

Annual Service Fee $

Transfer Fee $

Rollover Fee $

Termination Fee $

Other (Explain)

We reserve the right to change any of the above fees after notice to you,

as provided in your IRA agreement.

EARNINGS

The method for computing and allocating annual earnings (e.g., interest,

dividends) on your IRA will differ based on the nature and issuer of the

investments chosen. Refer to the investment prospectus or contract for

the methods used for computing and allocating annual earnings.

OTHER

Other terms or conditions that apply to your IRA include the following.

6098 / 2400R-C (Rev. 4/2020)

IRA Trustee Transfer

25.00

IRA Closeout

25.00

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